Why No Health Centres?
By SOMERVILLE HASTINGS, F.R.C.S., M.P.
WHEN Mr. Aneurin Bevan was piloting his new Health Bill-through Parliament he described health centres as the pivot of the whole scheme. And so they are, because health centres are the embodiment of a new conception with regard to health and disease, namely, that prevention 'and cure cannot be separated ; that the maintenance/of health is as important as the cure of disease, and that every doctor must take his share in both. The preventive and curative services-must therefore be brought together in health centres where the general practitioners will work with one another as a team, and with the specialists and clinic doctors, as well as with the midwives and home nurses and those outposts of the preventive system, the health visitors. - But health centres can as yet only be described as a closed book so far as this country is concerned. It is admitted that houses must come first. but it would be a real disaster if the time should arrive for building health centres with the necessary experience still unavailable. 1 am not aware that there is in Britain a single comprehensive health centre such as I have seen in other countries, nor do we yet know the type of centre most suitable to the genius of the British people, for this can only be discovered by experiment. According to the Minister of Health nine premises were taken over when the National Health Service began, and are in each case being administered as some form of health centre. One large comprehensive centre to provide accommodation for a group of doctors as well as for clinics and preventive services is under construction at Wood- berry Down, London, in a new housing area, and tenders for two smaller ones at Bristol and Farringdon have been invited.
But will these three buildings ever be completed as health centres, and will they then be staffed by doctors? Recently the London County Council wished to provide at the Hampstead Health Institute a modified health centre for group-practice by doctors, but this was turned down by the Ministry of Health because, it was stated, the area was already well supplied with doctors and surgeries. On April 14th, 1951, Mr: Marquand made clear the conditions under which he would be ready to entertain the provision of the simpler type of ,health centre. He said: " Where facilities are inadequate at the present time for a proper general practitioner service, for example on new housing estates, and where the doctors are willing to engage in group- practice, provision may be made for group-practice centres." But difficult as it has been to induce the Minister to agree to any form of health centre, to persuade the doctors to come in may be a problem of even greater magnitude as the experience of, Sheffield seems to show. In 1948 the Borough Council pro- posed to take over the Firth Park Maternity and Child Welfare Centre, and after necessary adaptation run it as a comprehensive health centre, and after general approval by the Minister of Health had been obtained. a start was made in the preparation of detailed plans. Six doctors agreed originally to move their practices to the new centre, but as time went on they became less keen, and were read) to be influenced.by the other doctors of the district, some of whom did not approve of the health- centre idea. At any rate. when a meeting of the doctors was called recently, they decided by a small majority against the scheme. The local Medical Committee agreed, therefore. to advise the local Executive Council not to recommend the con- tinuation of the health-centre plan. There the matter stands for the present, since the agreement of the local Executive Council is apparently necessary. Whether any change will yet take place in the attitude of the doctors remains to be seen.
The Minister in his statement on April 14th indicated, as 1 have said, that there were two conditions requisite for his sanction of any type of health centre—inadequate facilities for a proper general practitioner service and agreement by the doctors con- cerned. But the experience of Sheffield suggests that a third condition is required—the agreement of the doctors of the neigh- bourhood who will not be directly affected.
It is easy to understand why doctors should be a little slow to transfer their practices to a health centre. Many patients who enjoy good health and rarely consult a medical man are more concerned with a place than with an individual. If. therefore. a doctor moves his practice to a health centre, leaving his surgery to be occupied by another practitioner, there is a very good chance that many of his patients may not realise what has happened and turn up at the old surgery and be taken on by the new doctor. On the other hand, doctors who do not enter a health centre may fear that, owing to the better facilities, the association with prevention and the continuous service available there, they may lose patients, and self-interest may prompt them to oppose the introduction of a health centre into their area. And, besides all this, the Ministry has so far given local authori- ties no clear lead as to the charges they are to make to doctors for accommodation in health centres.
But in spite of all these difficulties there are few who will not agree that health centres are an essential part of a complete health service, and that only by trial and error can the best type or types of health centre be evolved, so that experiment is essential. Cannot the Minister of Health take a more active part in the solution of this problem? Cannot he use his influence to persuade the doctors to come in? Cannot he make the terms, at-any rate in some experimental centres, really attractive to the doctors? Cannot he import full-time practitioners when the local doctors persistently refuse to co-operate?
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